Rectal Foreign Body: A Case of Voluntary Insertion of a Perfume Bottle after Intoxication

Abstract

Purpose: Case Report: A 71-year-old man presented to the emergency room about 12 hours after inserting a perfume bottle into his rectum. Manual self attempts to remove the perfume bottle resulted in the cap getting stuck and moderate rectal bleeding. Patient reported that he had been drinking and snorting cocaine prior. He also reported abdominal pain, flatulence, distention, and the inability to void urine. The patient's vital signs were: temperature of 97.8°F (36.6°C), pulse of 101, respiratory rate of 16, and blood pressure of 162/87. Abdominal exam revealed a soft, distended abdomen with lower abdominal tenderness, but no rebound or guarding was present. On digital rectal exam, a foreign body could be palpated about 5 cm above the anal verge, but was unable to be retracted manually. Pelvic x-ray revealed an ovoid foreign body overlying the mid pelvis (Figure). The patient was taken to the operating room, where the foreign body was manually extracted under general anesthesia after anal dilation. The patient tolerated the procedure well, without any complications, and was discharged home two days later.Figure: Perfume cap in rectum.Discussion: Rectal foreign bodies are usually a result of deliberate insertion. However, some are a result of assault, iatrogenic, or due to foreign bodies traversing the digestive tract and becoming impacted in the rectum. Presentation usually involves abdominal pain, obstructive symptoms, and rectal bleeding. Perforation and signs of infection may be evident in complicated cases. Abdominal/pelvic x-rays should be obtained to delineate the foreign body position, shape, size and the presence of pneumoperitoneum. In stable patients without evidence of perforation or peritonitis, digital removal of the foreign body should be attempted first. Low-lying rectal foreign bodies can be removed using one of many clamps and/or instruments. Other methods of removal include endoscopic/fluoroscopic-guided balloon extraction, anal dilation with manual or forceps extraction under anesthesia. Laparotomy is indicated in patients who present with perforation, sepsis, ischemic bowel, or after failed transanal attempts.